Multilevel Modelling of Under-Five Time to Death, and Risk Factors

Abstract

Under-five mortality is a leading indicator of child health and overall development of a country. Sub-Saharan Africa remains the region with the highest under-5 mortality rate in the world, with 1 child in 13 dying before his or her fifth birthday. Half of all under-five deaths in 2019 occurred in just five countries: Nigeria, India, Pakistan, the Democratic Republic of the Congo, and Ethiopia. In Ethiopia, as the 2016 Ethiopia Demographic and Health Survey (EDHS) report showed that the under-five mortality declined from 166 deaths per 1,000 live births in 2000 to 67 deaths per 1,000 live births in 2019 mini EDHS report (60% decreasing rate). However, there are regional disparities problems on under-five children mortality in Ethiopia. Thus, the major purpose of this study was to model the multilevel effects of U5 child time to death, and to determine the risk factors for child’s death based on the last full report (2016 EDHS). The data were analysed using descriptive statistics, stratified Cox proportional hazards regression and multilevel parametric survival models. In the study, 635 (6.1%) U5 deaths have observed from 10,331 children. And, the overall probability of survival was 0.93. Results obtained by fitting both stratified Cox proportional hazards regression and lognormal parametric fixed-effect models: sex of child, type of birth, birth order, size (weight) of child at birth, months of breastfeeding, number of U5 and five children, family size, wealth index, frequency of listening radio, place of delivery place of residence, and geographical region were found to be significant factors for U5 children death or estimated mean survival time. Furthermore a high risk death of U5 children was found to be associated with male children, twined children, ≤ 6 months breastfeeding children, few number of children in the home, children from small family size, children average weight below, children from poor families, private health sectors delivered children, children from mothers didn’t not listen radio, children from rural areas, children from Afar, Somali and Harari regional states. In the lognormal parametric random effects model, 1.7 and 0.9 estimated variations were observed among regional and household cluster levels on U5 children mean survival times. The researchers recommended that governments, and other concerned bodies should give special supports for mothers whose children are at high risk of death.